Predicting corticosteroid response in chronic obstructive pulmonary disease using exhaled nitric oxide.
Am J Respir Crit Care Med
; 180(9): 846-52, 2009 Nov 01.
Article
em En
| MEDLINE
| ID: mdl-19661244
ABSTRACT
RATIONALE Predicting corticosteroid response in COPD is important but difficult. Response is more likely to occur in association with eosinophilic airway inflammation, for which the fraction of exhaled nitric oxide (Fe(NO)) is a good surrogate marker. OBJECTIVES:
We aimed to establish whether Fe(NO) levels would predict the clinical response to oral corticosteroid in COPD.METHODS:
We performed a double-blind, crossover trial of steroid in patients with COPD. After a 4-week washout of inhaled steroids, patients received prednisone 30 mg/d or matching placebo, in random order, with an intervening 4-week washout. The predictive values of Fe(NO) for clinically significant changes in 6-minute-walk distance (6MWD), spirometry (FEV(1)), and St. George's Respiratory Questionnaire (SGRQ) were calculated. MEASUREMENTS AND MAINRESULTS:
A total of 65 patients (mean FEV(1) = 57% predicted) were randomized. With prednisone, there was a net increase of 13 m in 6MWD (P = 0.02) and 0.06 L in postbronchodilator FEV(1) (P = 0.02) compared with placebo. The change in SGRQ was not significant. Using receiver operator characteristic analysis, the area under the curve for an increase of 0.2 L in FEV(1) was 0.69 (P = 0.04) with an optimum Fe(NO) cut-point of 50 ppb. The positive and negative predictive values were 67 and 82%, respectively. FE(NO) was not a significant predictor for changes in 6MWD or SGRQ.CONCLUSIONS:
Fe(NO) is a weak predictor of short-term response to oral corticosteroid in COPD, its usefulness being limited to predicting increase in FEV(1). Clinical trial registered with www.anzctr.org.au (ACTRN12605000683639).
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Prednisona
/
Corticosteroides
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Doença Pulmonar Obstrutiva Crônica
/
Expiração
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Anti-Inflamatórios
/
Óxido Nítrico
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2009
Tipo de documento:
Article